Avaliação da qualidade do sistema de informação do câncer do colo do útero (SISCOLO/SISCAN)
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Data
2016-03-04
Autores
Sartori, Mariana Cláudio da Silva [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: O Sistema de Informação do Câncer do Colo do Útero (SISCOLO) é uma ferramenta epidemiológica e tem por finalidade armazenar informações referentes a exames realizados na rede pública. Em 2011, o SISCOLO passou a integrar o Sistema de Informação do Câncer (SISCAN). Objetivo: Avaliar a qualidade do SISCOLO/SISCAN em um município do interior do Estado de São Paulo. Metodologia: Estudo transversal e de avaliação de sistemas de informação em saúde. Foi utilizada metodologia do Update Guidelines for Evaluating Disease Surveillance Systems - Center for Disease Control and Prevetion (EUA) e avaliados atributos qualitativos (simplicidade e qualidade dos dados), quantitativos (oportunidade e estabilidade) e sua utilidade. Foram analisados 761 exames citopatológicos do colo do útero de mulheres de Botucatu, registrados no banco de dados entre maio de 2014 e maio de 2015. Responderam questionário de avaliação do sistema 47 profissionais de unidade básica e dois do laboratório de referência. Resultados: As usuárias apresentaram idade média de 40 anos (DP = 15) e apresentaram, predominantemente, características como: ensino fundamental completo (79%), etnia caucasiana (84%) e não uso de anticoncepcional oral (79%). Já haviam realizado o exame anteriormente 82%, cujo motivo foi principalmente rastreamento (84%). Quanto aos resultados dos exames, três amostras foram rejeitadas na análise, sendo consideradas 758 amostras. A adequabilidade do material foi de 100%, com presença de epitélio escamoso (100%), glandular (58%) e metaplásico (19%). Na avaliação de simplicidade, apenas 15% dos profissionais afirmaram utilizar ou já terem utilizado o manual do SISCAN, e 14% das usuárias consideram o manual de fácil entendimento. O registro nas unidades de saúde para coleta de dados é realizado principalmente pela Ficha de Requisição (96%). Nas unidades de saúde, os profissionais que inserem os dados no sistema são auxiliares/ técnicos de enfermagem (96%), e gastam nessa atividade em média 13 minutos (min) (DP = 11). No laboratório, o tempo referido por um profissional foi de 30 minutos. Na avaliação de completitude das 14 variáveis avaliadas, 13 foram consideradas excelentes, com exceção para escolaridade. Ao serem comparados os dados da ficha de requisição aos do sistema, das cinco variáveis avaliadas, quatro apresentaram informação maior ou igual a 70%. Na avaliação de oportunidade, o número de dias entre coleta e digitação no sistema foi em média 26 dias (DP = 16); já entre a digitação e o resultado digitado pelo laboratório, em média 56 dias (DP = 28); entre o resultado e a liberação do exame, em média 5 dias (DP = 6); e entre a coleta e a liberação final do exame para impressão na unidade, em média 87 dias (DP = 31). Na avaliação de estabilidade, 55% dos profissionais relataram que o sistema havia ficado inoperante mais de uma vez na última semana, e 92% no último mês. Na avaliação de utilidade, considerando os objetivos do sistema, identificou-se que para 75% dos profissionais o sistema atende parcialmente seus objetivos, e para 25% ele não os atende. Conclusões: O sistema foi avaliado como simples, mas com baixa aceitabilidade pelos profissionais e subutilizado, e seu manual foi considerado de difícil entendimento pelos profissionais. O mesmo é instável e atinge parcialmente seus objetivos. O sistema apresentou bons resultados na avaliação de completitude, uma vez que a maioria dos itens é de preenchimento obrigatório, com exceção de um item não obrigatório (escolaridade). A consistência dos dados foi considerada regular. O tempo de disponibilização dos resultados foi quase três vezes acima do esperado, impactando negativamente o seguimento e o início do tratamento de mulheres com lesões precursoras do câncer. Aponta-se a necessidade de estudos de avaliação do sistema em diferentes cenários, permitindo comparações. Como produto deste estudo, são apresentadas recomendações do sistema aos níveis municipal e federal.
Introduction: The Information System of Cervical Cancer (SISCOLO) is an epidemiological tool and aims to store information relating to examinations performed in public network; in 2011 the SISCOLO joined the Cancer Information System (SISCAN). Objective: To evaluate the quality of SISCOLO/SISCAN in a city in the interior of the State of Sao Paulo. Methods: Cross-sectional study and evaluation of health information systems. The Update Guidelines for Evaluating Disease Surveillance Systems - Center for Disease Control and Prevention (USA) methodology was used and qualitative attributes were evaluated (simplicity and quality of data), quantitative (opportunity and stability) and its usefulness. 761 cytopathology cervical cancer exams were analyzed in women from Botucatu which were registered in the database between May 2014 and May 2015. A system evaluation questionnaire was replied for 47 professionals from the basic health unit and two professionals from the reference laboratory. Results: The users had an average age of 40 years old (SD=15) and referred, predominantly, completed elementary school (79%), white (84%), not to use oral contraceptives (79%); had undergone the examination previously 82%; the reason of the exam was, most of all, tracking survey (84%). Regarding the exams results, three samples were rejected in the analysis, being considered 758 samples. The suitability of the material was 100%, with the presence of squamous epithelium (100%), glandular (58%) and metaplastic (19%). In the evaluation of simplicity, only 15% of professionals claimed to use/ have used the SISCAN manual and 14% consider the manual easily comprehensible; registration in health facilities to collect data is realized mainly by Request Form (96%). In the health facilities, professionals who insert data in the system are nursing auxiliaries/ technicians (96%) and spend an average of 13 minutes (SD=11); in the laboratory however, the time referred by a professional was 30 minutes. In the evaluation of completeness, from the 14 variables studied, 13 were considered excellent, with the exception of the schooling. Comparing the data of the request forms to the system’s, from the five variables evaluated, four of them presented information higher or equal to 70%. In the evaluation of opportunity, the number of days between collection and typing in the system were about 26 days (SD=16); days between typing and results entered by the laboratory were 56 days (SD=28); days between the result and the release of the exam were about 5 days (SD=6); days between the collection and the final exam release to be printed in the unit were about 87 days (SD=31). In the evaluation of stability, 55% of professionals reported that the system had been inoperative more than once in the last week and 92% of professionals reported it in the last month. In the evaluation of utility, considering the aims of the system, it was identified that to 75% of professionals, the system meets partly of the expectations and neglects to 25% of them. Conclusions: The system was evaluated as simple, however, with low admission by professional and underused; professionals considered its manual of hard understand, unstable and meeting partially its aims. The system presented good results in the evaluation of completeness, since most items are mandatory, with the exception of one non-mandatory item (schooling). The consistency of the data was considered regular. The delivery time of the results was almost three times higher than expected, negatively impacting the monitoring and early treatment of women with precursor lesions of cancer. It points out the need of assessment studies of the system in different scenarios, allowing comparisons. As a product of this study a list of system recommendations to municipal and federal levels was built.
Introduction: The Information System of Cervical Cancer (SISCOLO) is an epidemiological tool and aims to store information relating to examinations performed in public network; in 2011 the SISCOLO joined the Cancer Information System (SISCAN). Objective: To evaluate the quality of SISCOLO/SISCAN in a city in the interior of the State of Sao Paulo. Methods: Cross-sectional study and evaluation of health information systems. The Update Guidelines for Evaluating Disease Surveillance Systems - Center for Disease Control and Prevention (USA) methodology was used and qualitative attributes were evaluated (simplicity and quality of data), quantitative (opportunity and stability) and its usefulness. 761 cytopathology cervical cancer exams were analyzed in women from Botucatu which were registered in the database between May 2014 and May 2015. A system evaluation questionnaire was replied for 47 professionals from the basic health unit and two professionals from the reference laboratory. Results: The users had an average age of 40 years old (SD=15) and referred, predominantly, completed elementary school (79%), white (84%), not to use oral contraceptives (79%); had undergone the examination previously 82%; the reason of the exam was, most of all, tracking survey (84%). Regarding the exams results, three samples were rejected in the analysis, being considered 758 samples. The suitability of the material was 100%, with the presence of squamous epithelium (100%), glandular (58%) and metaplastic (19%). In the evaluation of simplicity, only 15% of professionals claimed to use/ have used the SISCAN manual and 14% consider the manual easily comprehensible; registration in health facilities to collect data is realized mainly by Request Form (96%). In the health facilities, professionals who insert data in the system are nursing auxiliaries/ technicians (96%) and spend an average of 13 minutes (SD=11); in the laboratory however, the time referred by a professional was 30 minutes. In the evaluation of completeness, from the 14 variables studied, 13 were considered excellent, with the exception of the schooling. Comparing the data of the request forms to the system’s, from the five variables evaluated, four of them presented information higher or equal to 70%. In the evaluation of opportunity, the number of days between collection and typing in the system were about 26 days (SD=16); days between typing and results entered by the laboratory were 56 days (SD=28); days between the result and the release of the exam were about 5 days (SD=6); days between the collection and the final exam release to be printed in the unit were about 87 days (SD=31). In the evaluation of stability, 55% of professionals reported that the system had been inoperative more than once in the last week and 92% of professionals reported it in the last month. In the evaluation of utility, considering the aims of the system, it was identified that to 75% of professionals, the system meets partly of the expectations and neglects to 25% of them. Conclusions: The system was evaluated as simple, however, with low admission by professional and underused; professionals considered its manual of hard understand, unstable and meeting partially its aims. The system presented good results in the evaluation of completeness, since most items are mandatory, with the exception of one non-mandatory item (schooling). The consistency of the data was considered regular. The delivery time of the results was almost three times higher than expected, negatively impacting the monitoring and early treatment of women with precursor lesions of cancer. It points out the need of assessment studies of the system in different scenarios, allowing comparisons. As a product of this study a list of system recommendations to municipal and federal levels was built.
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Palavras-chave
Saúde da mulher, Epidemiologia, Sistemas de informação em saúde, Câncer do colo do útero, Women's health, Epidemiology, Information systems in health, Cervical Cancer